NOW LIVE: Obtain A Final Conditional Payment Amount Prior to Settlement
January 11, 2016
It’s here! The ability to obtain a Final Conditional Payment Amount prior to settlement has gone live. As we discussed in November, as part of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act), the MSPRP was to be modified to include a new functionality allowing authorized MSPRP users to notify CMS that a recovery case is 120 days (or less) from an anticipated settlement and request that a final conditional payment amount is provided. CMS’ December 21st alert states that:
“This new functionality provides authorized MSPRP users with the option to notify CMS that a recovery case is 120 days (or less) from an anticipated settlement, ensure that relatedness disputes are addressed within 11 business days of receipt of dispute documentation, request a Final Conditional Payment Amount, and obtain a time and date stamped final conditional payment summary document before reaching settlement. Once the Final Conditional Payment has been calculated, this amount will not change as long as:
1. The case is settled within 3 calendar days of requesting the Final Conditional Payment Amount, and 2. Settlement information is submitted through the MSPRP within 30 calendar days of requesting the Final Conditional Payment Amount.
A request for a Final Conditional Payment Amount can only be done once per case. If the case is not settled with 3 days and/or the settlement information is not submitted through the MSPRP within 30 calendar days, the Final CP process will be voided. At that time new claims may be added to the case and the CP amount will be modified accordingly. Also, any subsequent disputes will not be held to the 11 day resolution timeframes.
Important Note: An insurer and their authorized representatives can initiate the Final CP process on their insurer-debtor case as long as a settlement is pending on the case and no outstanding Ongoing Responsibility for Medicals (ORM) exists. Once the Final CP process has been started on an insurer-debtor case, the following events will occur:
• The insurer-debtor case will be closed and the debt will be transferred to a new case where the beneficiary is the identified debtor. • The insurer and their authorized representatives will not be able to work the new beneficiary-debtor case or receive copies of any recovery-related correspondence related to the new beneficiary-debtor case until they obtain and submit an authorization signed by the beneficiary.”
As you can see, CMS provided additional information in their most recent alert regarding the new MSPRP functionality. Most notably, the parties are allowed only one download from the MSPRP when requesting the final conditional payment amount prior to settlement. Furthermore, it appears to place restrictions on obtaining the final demand amount in an insurer-debtor case. We will keep you posted regarding any changes to this process.